My patient mentioned that they had struggled with weight gain, and despite having tried a variety of diets over the course of their lifetime, they’d never found a sustainable way of losing weight that worked for them.
This meant that they struggled with periods of eating well (but feeling very restricted), and then followed with periods of not caring about nutrition, overeating and struggling to find a way to make nutritious food choices.
The patient was really frustrated by their inability to make long-lasting changes, despite feeling like they’d tried every type of diet, diet programme and group to change things. One of their biggest frustrations was feeling like they knew what they should be doing, they just couldn’t do it.
They were advised to try using the nutrition service available by a work colleague, and were hoping that a conversation with a professional could help support them.
Assessment of baseline nutrition
When discussing the patient’s current dietary intake, it was clear that they were inconsistent with their food choices and meal patterns, and this was contributing to their issues with managing their calorie intake.
The patient was often not having breakfast, and as they were often on the road they were choosing lunch from shops and services and were limited with their food choices. The patient also highlighted that they were struggling with snacking on high calorie, low nutrient dense foods in both the afternoon and the evening. Finally, they mentioned that they’d not been as active recently as they had previously.
We established that breakfast was a key component on ‘good days’ for the patient. The main barriers to consistency with breakfast were time and enjoyable options, so we collaborated on some simple and nutritious breakfast choices that didn’t take long to prepare, and could be taken to work if needed. As part of the patient’s notes, I sent over a variety of overnight oats recipes, as they suggested they’d enjoyed them in the past.
The other key change we made to their nutrition, was to plan evening meals that were high protein, had several servings of vegetables and a source of wholegrains to maximise fullness. With some recipe ideas agreed on for dinner (and more sent with notes), for ease of preparation we decided that a simple strategy to change lunch would be to cook twice as much dinner and have some for lunch the next day.
By changing the patient’s meal timings, adding breakfast and including more plants and more protein, we devised a plan that felt achievable for them and would provide more satisfaction from meals, as well as reduce their energy intake.
As well as making simple nutritional changes to support their goals, we also discussed some of the behavioural barriers that were holding back the patient from their weight loss goal.
The one primary barrier was that they were turning to food when they were bored in the afternoon, and then again when they were feeling stressed and fatigued in the evening. To help overcome this, we discussed ways to create a pause and to check in with how they were feeling, so they could better identify their feelings and emotions and then find appropriate alternative coping strategies, such as a quick walk or a 5 minute break from screens.
A second issue discussed was that meals were often consumed in front of the TV or on the go, which meant that the patient was not fully paying attention to their food, meals and snacks were often consumed mindlessly and this meant that they always cleared their plate, as well as suffering some bloating and indigestion after the meal. We worked on strategies to help them eat more mindfully without distraction, chewing their food and checking in with hunger signals to finish when they’d had enough food, not necessarily when they’d cleared their plate.
The patient was delighted that they’d been able to address some nutritional changes that felt very simple and straightforward, especially when compared to previous diets and weight loss attempts. But they were also relieved that we discussed some of the underlying behavioural factors contributing to their eating, as they knew that without understanding and changing these, they would struggle to consistently change their eating behaviours.
They were optimistic of their chances of success, and looking forward to putting themselves and their health first.
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